Now just two days past delivery, the baby was battling the initial stages of withdrawal, which at the least includes agitation and sensitivity to light, and often results in violent vomiting, shrieking and bouts of sweating.

“Their heels and chins and noses are raw because they are always rubbing themselves. It is very hard on the tiny bodies,” said Carol Jordan, director of women and children’s services at Baptist Health Hospital in Corbin, where the baby was born.

Machines whirred and monitors beeped quietly as a nurse tiptoed past the newborn’s incubator to check her vitals. Moments later, as the nurse gently massaged the soles of the baby’s feet, her body relaxed.

In this neonatal intensive care unit, nurses are used to administering around-the-clock soothing for babies born dependent on opioids or other drugs because their mothers used during pregnancy. In some cases, an addiction to prescribed painkillers will have led to use of heroin, another opioid.

Opioids were involved in 42,200 overdose deaths nationwide in 2016, according to the U.S. Centers for Disease Control and Prevention, and they harmed the lives of thousands more. Many of those victims were children, and none are more vulnerable than the newborns undergoing treatment in intensive care units across the country.

An estimated 21,700 babies in 2012 were born with neonatal abstinence syndrome, often caused by a mother’s use of opioids during pregnancy. The number represents a fivefold increase since 2000, according to the National Institute on Drug Abuse, a branch of the National Institutes of Health.

Baptist Health delivers 1,000 babies a year, including some from families in far Western North Carolina counties. Roughly one in four are found to have been exposed to opioids while in the womb. Of those, 25 percent will need treatment for withdrawal.

For many, their first days of life are torturous. Whether they will suffer long-term damage is unclear.

CLOSE

Sherrie Mays, the vice president of and the chief nursing officer at Baptist Health hospital in Corbin Kentucky, discusses the opioid epidemic and babies who are born dependent on opioids.
Matt Burkhartt/mburkhartt@citizen-times.com

Blue collar roots

The opioid epidemic has the hit the Appalachian region particularly hard and left Baptist Health in its wake.

Only five other states had an opioid overdose death rate higher than Kentucky in 2015, according to the nonprofit Kaiser Family Foundation. Those five included neighboring West Virginia and Ohio, also Appalachian states.

In Corbin, antique shops and a handful of restaurants line downtown’s Main Street. On a weekday afternoon in January, most were closed, some permanently.

“Corbin was once a city supported by the manufacturing and coal industries,” said Sherrie Mays, vice president and chief nursing officer at Baptist Health.

An infant born dependent on opioids in an incubator at Baptist Health Hospital's neonatal intensive care unit, or NICU, in Corbin Kentucky. The unit features dim lighting to reduce stimulants to the babies as part of their treatment. Nearly a quarter of the babies delivered at Baptist Health are born to mothers who used opioids or other substances during pregnancy.(Photo: Matt Burkhartt/mburkhartt@citizen-times.com)

“We are a classic blue-collar, working-class community surrounded by rural counties,” said Mays, a nurse practitioner in her hometown of Corbin for more than 30 years. “Many of our residents struggle with poverty, making them more susceptible to the opioid epidemic.”

Industries that once provided a means of living are gone, leaving the southeastern Kentucky town’s 8,000 residents and a generation of children grappling with the drug crisis.

Jobs outside the hospital, one the area’s top employers, often come with physical demands that can lead to injury — and then to a prescription for painkillers often later used to cope with the stress of living paycheck-to-paycheck.

Other hospitals in and surrounding WNC have seen surges in the number of babies born to mothers who used during pregnancy, including those in Asheville and the Tennessee cities of Knoxville, Chattanooga and Nashville.

“We were left wondering: What is happening outside the NICU to these mothers that’s contributing to what’s going on inside?” said Dr. Stephen Patrick, an assistant professor of pediatrics and health policy at Vanderbilt University School of Medicine in Nashville and an attending neonatologist at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

The numbers recorded at Mission Hospital have been steadily rising for seven years but spiked from 2010-13, said Dr. Susan Mims, the hospital vice president for children’s services and executive medical director for Mission Children’s Hospital.

Fewer than 50 babies were born to substance-using mothers before their numbers began to surge in 2010. That has since risen to more than 400 last year.

“We saw this as a really big problem,” Mims said.

East Tennessee Children’s Hospital in Knoxville saw its numbers almost double from 2011-13, from 139 babies born dependent to 258.

In Greensboro, North Carolina’s third most populous city, Moses H. Cone Memorial Hospital delivers close to 7,000 babies a year. More than 600 last year were born to mothers who had abused substances, mainly opioids and poly substances, which can be a mixture of opioids with other substances.

Jenny Grayer, a neonatal nurse practitioner, works with babies that are born dependent on opioids at Cone Health Women's Hospital in Greensboro.(Photo: Angela Wilhelm/awilhelm@citizen-times.com)

Of those 600 newborns, 10 percent were transferred to the hospital’s neonatal intensive care unit to be treated for opioid withdrawals, which could mean close to a monthlong stay in the NICU. That amounts to about 60 opioid-dependent babies a year, said Jennifer Grayer, a nurse practitioner.

With the increases have come financial burdens for hospitals.

“A NICU stay is probably one of the costliest things we have in our health care system,” Mims said.

An infant born without complications has an average two-day stay in a hospital, which costs around $3,500, according to the CDC.

An infant needing treatment for neonatal abstinence syndrome will stay 16 days on average, costing $66,700 a baby.

Babies needing treatment for neonatal abstinence syndrome cost U.S. hospitals $1.5 billion in 2012, with most charges paid by state Medicaid programs, according to the National Institute on Drug Abuse.

“A NICU stay is probably one of the costliest things we have in our health care system.”

Dr. Susan Mims

When Grayer first started treating opioid-dependent babies, she said it was so far from her lifestyle she didn’t understand why the numbers were so high.

“You look at a baby who is starving but is so frantic that they can’t coordinate their ability to feed and then if they do feed they vomit all over the place,” Grayer said. “It took a lot of education on my part to understand how this problem evolved so that I could be able to treat this with more compassion.”

Treating the babies

Corbin's Baptist Health has made ensuring compassion a priority.

On that January day, the unit was dimly lit and blankets covered incubators to block light that might disturb babies being treated for opioid withdrawal.

The 2-day-old prematurely born baby weighing all of 4 pounds was noticeably uncomfortable. Her face was scrunched and her body jerked from side to side as she tried to relax. She silently opened and closed her mouth, like she wanted to cry out but could not.

“It is sad to see them go through their symptoms because it is just like an adult going through a withdrawal,” said Jordan, the Women and Children’s Services director.

Doctors and nurses try to treat babies first with holistic options, such as decreasing stimuli, swaddling, dark rooms and a calming atmosphere, Jordan said.

But if the baby’s withdrawal symptoms continue, they move to pharmaceutical intervention, using morphine and methadone, also opioids. This can extend a baby’s stay for up to one month.

To meet the needs of their growing opioid-dependent newborn population, many hospitals have had to get creative. At Baptist Health, Mission and Cone Health, volunteers cuddle babies for hours. The skin-to-skin contact eases a baby’s pain, Grayer said.

When a mom or dad is available to hold their baby for long periods of time, Grayer said it is the best medicine for withdrawal.

“Their heart rates slow down, they wean off medications earlier, and they calm down with more parental involvement,” she said.

This type of extreme nurturing has become normal at hospitals in recent years. Staff members have been retrained and taken trauma sensitivity workshops to learn about the opioid epidemic so they could better treat both affected babies and mothers without judgment.

“We experienced a lot of frustration at first because most of us were wondering, how could this happen to babies? How could a mama let this happen?” said Mays, the vice president and chief nursing officer at Baptist Health. “But as you dive into it, the addiction piece is very strong and you have to treat the mama, too, in order to stop this.”

“We have to keep educating people that this is a medical condition,” said Mims, Mission’s vice president for children’s services. “We don’t ask people why they have diabetes, but for some reason we do that with substance abuse disorder.”

Some people who are exposed have a genetic predisposition, Mims emphasized, and it affects them more strongly.

Instead of asking people who are struggling with this disease "What’s wrong with you?" Mims said she asks people, "What happened to you?"

Crystal Sweatt is the manager of the McDowell Mission Ministries in Marion. In the last two years the population of the 41-bed shelter for women and children has grown to be 92 percent substance abuse clients. Sweatt is also recovering from substance abuse disorder and an opioid addiction that caused her to lose her children for years. "I feel that God has put me in this position because I have experience and have lived experience to offer hope to people who are going through the same things I've gone through," she said.(Photo: Angeli Wright/awright@citizen-times.com)

Finding help

Having suffered through years of addiction and the loss of two children, Crystal Sweatt wishes others had the same understanding at the time her life unraveled.

Today, the 36-year-old is mom to two and an inspiration for the women seeking refuge at McDowell Mission Ministries, a homeless shelter for women that operates under her direction.

What happened to Sweatt in her early 20s is an increasingly common story of addiction. She started experimenting with marijuana at 12 and by 16 had moved on to cocaine.

As a teenager, Sweatt said she battled anxiety and depression. She spent most of her time in her room or out with friends experimenting, anything to escape, she said.

After she gave birth to her daughter at 21, she was prescribed medication for anxiety.

“The first time I took the benzo pill, it was immediate abuse because of the way it made me feel,” Sweatt said. “I took one and then I took a handful and that just continued for probably 10 years.”

A losing battle to overcome an opioid addiction in the years that followed cost her custody of her daughter.

She said she used during her second pregnancy, and her son, now 6, tested positive for opioids hours after she gave birth at Mission Hospital. Social services intervened again and sent her newborn to live with a relative.

CLOSE

Crystal Sweatt's opioid addiction was so bad that she lost custody of her children. After court-ordered treatment and Christ-centered recovery she believes her experience is best used helping others battling addiction.
Angeli Wright/awright@citizen-times.com

"It crippled me and stole my soul. I had nothing when they took my children from me,” Sweatt said.

Over the years of estrangement from her children, Sweatt said she tried to meet court mandates and social services requirements to stay sober and get her children back.

“They wanted me to do parenting classes, treatment, anger management, hair samples, drugs screens, meet probation officers, a giant list of things, and every time I accomplished one of them nobody congratulated me or even truly believed that I was sober,” she said.

“I feel like if they would’ve asked, ‘What could we do to help you because we know you have an illness that needs to be treated?' or if they could have been somehow loving when they took my children away, it wouldn’t have forced me deeper into my disease,” Sweatt said.

Today, she said she is more than four years sober and has both children in her care.

She can relate to women staying in the shelter she runs. Most are battling substance abuse of some kind, commonly addictions to opioids and methamphetamine.

As she walked to a downstairs kitchen during a recent interview, women cooked lunch while a handful of children watched cartoons or drew pictures on a chalkboard. Toys were scattered about plastic playground equipment.

The women may come and go, and if they do relapse, Sweatt and her team will often work to get help, as opposed to kicking them out.

“It’s a special place and I don’t think there is anything else of its kind in all of North Carolina,” Sweatt said.

Crystal Sweatt is the manager of the McDowell Mission Ministries in Marion. In the last two years the population of the 41-bed shelter for women and children has grown to be 92 percent substance abuse clients. Sweatt is also recovering from substance abuse disorder and an opioid addiction that caused her to lose her children for years. "I feel that God has put me in this position because I have experience and have lived experience to offer hope to people who are going through the same things I've gone through," she said.(Photo: Angeli Wright/awright@citizen-times.com)

Finding ways to help

Through the work of people like Sweatt, the opioid epidemic is helping to change the perception of addiction, said Melinda Ramage, a family nurse practitioner on the maternal fetal medicine team for MAHEC, which serves 16 Western North Carolina counties and trains physicians and other health care professionals.

“I think what opioids are bringing to light is how poorly we screen people and how uncomfortable we are when talking to patients about treating their disease,” Ramage said.

In the past, obstetricians were reluctant to treat women battling addiction while pregnant, she said.

“They practically ran them out of the office because doctors have very little addiction training; maybe eight hours in four years of medical school will be focused on that,” Ramage said. “But with the opioid epidemic, we are not allowing this. We are screaming that it has to be different.”

As the epidemic is seen more as illness than weakness of character, hospitals must develop ways to follow up with mothers who have suffered addictions, said Grayer, of Cone Health in Greensboro.

Cone Health recommends that babies born dependent return to the clinic for developmental follow-ups until they are 2.

That rarely happens.

“More than 60 percent of these parents never even show up for the first appointment,” Grayer said. “A lot of times they want to but physically can’t make it because they don’t have transportation or they have to work.”

She fears what happens to the babies when they go home. That’s where hospitals typically stop being involved and social services takes over.

A bible verse is written on the chalkboard in a children's play area of the McDowell Ministries Friendship Home in Marion. In the last two years the population of the 41-bed shelter for women and children has grown to be 92 percent substance abuse clients. (Photo: Angeli Wright/awright@citizen-times.com)

The debate

“There have been talks of linkages to long-term challenges, but we can’t really say one way or the other,” said Dr. Chris DeRienzo, chief quality officer at Mission Hospital and a neonatologist.

Mims, who worked in pediatrics for 11 years, said there are no obvious signs of long-term impact, but subtle behavioral changes in children could show over time.

For Dr. Gary Bell, a neonatologist at Erlanger Medical Center in Chattanooga, it is obvious: Opioid dependency at birth will show in the behavior of child years later, he said.

"I do believe that there are more kids in schools now with behavioral issues because of their experiences with drug withdrawals as a baby,” said Bell, who has been working with newborns for more than 30 years. “I don’t believe it is anything life threatening, but there are problems long term.”

Patrick, the attending neonatologist at the children's hospital at Vanderbilt, has made researching neonatal abstinence syndrome at the national level his focus over the past decade, but he acknowledges too little is known now about the potential for long-term harm.

Patrick's research shows some babies may experience developmental delays, have a lower IQ and exhibit behavioral problems.

"What we really need is a large study that will follow infants that had drug withdrawals through school,” he said.

He worries that hospitals are sometimes too quick to start newborns on a pain management regimen.

"I know of one hospital that treats all opioids-exposed infants instantly on methadone, which I think is excessive in some cases,” Patrick said.

Because of his concerns, Patrick created new initiatives that involve keeping mothers and babies together in places away from stress.

“We had one baby that was in the NICU for over three weeks, and we kept escalating their medications,” Patrick said. “But then we transferred the baby out of the NICU to a room where the mom could hold her infant, and then we were able to quickly wean the baby off all drugs.”

While medical care is a significant issue, Jordan and Mays said they worry most about what happens to the babies when they return to homes where drug use is prevalent.

“This impacts the community as a whole and as much as we try to help all of these kids as they move through school, some of them are out of our reach and fall into the same trap as their parents,” Mays said. “But when you have generations that have lived this lifestyle, it is difficult to break it for these children."

Coming Tuesday: The inability to break out of the addiction lifestyle for youth has become deadlier in the age of opioids. In high schools, school resource officers and school nurses are being equipped with the overdose-reversal drug naloxone.

Loading...

Alexandria Bordas is a reporter at the Asheville Citizen Times. You can reach her at abordas@citizentimes.com.